Provider Demographics
NPI:1235748104
Name:MPUATI, ASIA EMANI
Entity Type:Individual
Prefix:
First Name:ASIA
Middle Name:EMANI
Last Name:MPUATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4952 MCALPINE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-8547
Mailing Address - Country:US
Mailing Address - Phone:704-208-0286
Mailing Address - Fax:
Practice Address - Street 1:4952 MCALPINE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8547
Practice Address - Country:US
Practice Address - Phone:704-208-0286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC57577376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide